Healthcare Provider Details

I. General information

NPI: 1508670282
Provider Name (Legal Business Name): LEEJAE SUE WANSING MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9927 NE 98TH ST
KANSAS CITY MO
64157-7788
US

IV. Provider business mailing address

9927 NE 98TH ST
KANSAS CITY MO
64157-7788
US

V. Phone/Fax

Practice location:
  • Phone: 816-868-5435
  • Fax:
Mailing address:
  • Phone: 816-868-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number2024104458
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: